Vascular Surgery Group, Department of Cardiovascular Sciences, University of Leicester, Leicester, UK.
Br J Surg. 2013 Sep;100(10):1262-70. doi: 10.1002/bjs.9181.
The aim was to assess the risk of rupture, and determine the benefits of intervention for the treatment of type II endoleak after endovascular abdominal aortic aneurysm repair (EVAR).
This systematic review was done according to PRISMA guidelines. Outcome data included incidence, spontaneous resolution, sac expansion, interventions, clinical success, and complications including conversion to open repair, and rupture.
Thirty-two non-randomized retrospective studies were included, totalling 21 744 patients who underwent EVAR. There were 1515 type II endoleaks and 393 interventions. Type II endoleak was seen in 10·2 per cent of patients after EVAR; 35·4 per cent resolved spontaneously. Fourteen patients (0·9 per cent) with isolated type II endoleak had ruptured abdominal aortic aneurysm; six of these did not have known aneurysm sac expansion. Of 393 interventions for type II endoleak, 28·5 per cent were unsuccessful. Translumbar embolization had a higher clinical success rate than transarterial embolization (81 versus 62·5 per cent respectively; P = 0·024) and fewer recurrent endoleaks were reported (19 versus 35·8 per cent; P = 0·036). Transarterial embolization also had a higher rate of complications (9·2 per cent versus none; P = 0·043).
Aortic aneurysm rupture after EVAR secondary to an isolated type II endoleak is rare (less than 1 per cent), but over a third occur in the absence of sac expansion. Translumbar embolization had a higher success rate with a lower risk of complications.
本研究旨在评估破裂风险，并确定血管内腹主动脉瘤修复（EVAR）后 II 型内漏的治疗干预的获益。
本系统评价按照 PRISMA 指南进行。结局数据包括发生率、自发缓解、瘤腔扩张、干预措施、临床成功率和并发症，包括转为开放修复和破裂。
共纳入 32 项非随机回顾性研究，共计 21744 例接受 EVAR 的患者。共发现 1515 例 II 型内漏和 393 例干预措施。EVAR 后 II 型内漏的发生率为 10.2%；35.4%自发缓解。14 例（0.9%）孤立性 II 型内漏患者发生腹主动脉瘤破裂；其中 6 例患者瘤腔无已知扩张。393 例 II 型内漏干预中，28.5%不成功。经皮经肝穿刺栓塞术的临床成功率高于经动脉栓塞术（分别为 81%和 62.5%；P=0.024），且报道的复发性内漏较少（19%和 35.8%；P=0.036）。经动脉栓塞术的并发症发生率也更高（9.2%和无；P=0.043）。
EVAR 后孤立性 II 型内漏导致的腹主动脉瘤破裂罕见（不足 1%），但超过三分之一的破裂发生在瘤腔无扩张的情况下。经皮经肝穿刺栓塞术的成功率更高，并发症风险更低。
